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Ann Thorac Surg 2006;81:2172-2178
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Short- and Long-Term Results of Triple Valve Surgery in the Modern Era

Peter Munk Cardiac Center, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada

Accepted for publication January 17, 2006.

^_* Address correspondence to Dr Rao, Alfredo and Teresa DeGasperis Chair in Heart Failure Surgery, Toronto General Hospital, 200 Elizabeth St, Toronto, Ontario, Canada, M5G 2C4. (Email: vivek.rao{at}uhn.on.ca).

Presented at the Fifty-second Annual Meeting of the Southern Thoracic Surgical Association, Orlando, FL, Nov 10–12, 2005.

BACKGROUND: Triple valve surgery is usually complex and carries a reported operative mortality of 25% and 10-year survival of 40%. We examined surgical results in the modern era.

METHODS: A total of 174 consecutive patients, mean age 58 ±12 years underwent triple valve surgery from 1990 to 2004. The most common aortic and mitral valve disease was rheumatic disease (61%), followed by prosthetic valve dysfunction (22%). Tricuspid valve disease was functional regurgitation in 72% of patients. Ninety-four percent of patients were in New York Heart Association class III and IV, and 60% had had previous cardiac operations. The aortic valve procedures consisted of 160 replacements and 14 repairs, the mitral valve procedures, 153 replacements and 21 repairs, and the tricuspid valve procedures, 12 replacements and 162 repairs. Univariate and multivariable analyses were performed to identify predictors of early and late survival.

RESULTS: Operative mortality was 13% (n = 22). Univariate factors associated with mortality included urgent surgery, shock, tricuspid valve replacement, preoperative renal failure, and peripheral vascular disease. Survival at 5 and 10 years was 75% and 61%, respectively. Seventy-three percent of patients were in New York Heart Association class I and II at their most recent follow-up. Ten-year freedom from thromboembolism was 88%, from anticoagulation-related hemorrhage, 83%, from endocarditis, 96%, and from cardiac reoperation, 92%.

CONCLUSIONS: Patients with advanced rheumatic valve disease and prosthetic valve dysfunction are at risk for requiring triple valve surgery. Compared with historic reports, the results of triple valve surgery, primary and reoperative, have improved. Although early mortality is high, long-term and event-free survival are comparable with that of patients undergoing single valve replacement.

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